Orthostatic Vital Signs (Ambulatory) - CE
Learn more about Clinical Skills today! Standardize education and management competency among nurses, therapists and other health professionals to ensure knowledge and skills are current and reflect best practices and the latest clinical guidelines.
Do not check orthostatic vital signs in patients with supine hypotension, shock, or severe alteration in mental status or in those who may have spinal, pelvic, or lower extremity injuries.undefined#ref3">3
Medications that block a patient’s normal vasomotor and chronotropic response will interfere with fluid volume evaluation; however, to evaluate a patient’s reaction to a medication, obtaining orthostatic vital signs can be helpful.
Anticipate that the patient may experience dizziness and that an assistant may be necessary to help move the patient from a lying to a standing position. Do not leave the patient alone during this procedure.
Orthostatic vital signs are performed with the patient in different positions. The measurement of orthostatic vital signs is sometimes referred to as postural vital signs or the tilt test. This measurement is used for noninvasive evaluation of fluid loss from conditions such as vomiting, diarrhea, diaphoresis, bleeding, abdominal pain, and blunt abdominal or chest trauma. A patient presenting with blood loss, diarrhea, or vomiting should be evaluated for orthostatic hypotension due to possible hypovolemia.5 Other indications for obtaining orthostatic vital signs include unexplained syncope, weakness or dizziness, and falls.5 A set of orthostatic vital signs can also help identify an isolated low blood pressure measurement.5 Orthostatic hypotension is impacted by increasing age, diagnosis of hypertension, and polypharmacy, including use of multiple antihypertensive medications.5
The value of orthostatic vital signs is disputed because there is no universal method on how to perform them or what blood pressure and heart rate changes constitute “positive orthostatics.” Orthostatic vital sign measurements are more accurate in suggesting hypovolemia than supine vital sign measurements alone.5 Therefore, the vital signs should be interpreted in the context of the patient’s other symptoms, such as dizziness, lightheadedness, fatigue, visual dimming, and shoulder pain.5 These symptoms can be aggravated by hot environments and in patients who tend to stand still without frequently changing position. Signs and symptoms of orthostatic changes are typically not present when the patient is supine but mostly materialize when moving into the standing position and can be quickly resolved by sitting or lying down.5
Another complicating factor in interpreting orthostatic vital signs is the development of paradoxical bradycardia associated with blood loss, trauma, or surgery. Bradycardia due to blood loss, trauma, or surgery has generally been considered a preterminal finding of irreversible shock, and bradycardia has been documented in hypovolemic, conscious trauma patients as well. It has been reported that when orthostatic syncope occurs, it is accompanied by hypotension and often bradycardia.3
See Supplies tab at the top of the page.
Rationale: Some commonly prescribed medications can affect the heart rate.1 Drugs such as alpha blockers, beta blockers, tricyclic antidepressants, and antipsychotics have been associated with an increased finding of orthostatic hypotension.1 Further, angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers can cause autonomic nervous system insufficiency.2
Rationale: The patient should be in a flat, supine position for the blood pressure to even out to a baseline supine pressure.
Prevent unreliable results by avoiding invasive or painful procedures during the measurement of orthostatic vital signs.
Do not use a cuff that is too small because it can result in falsely high readings. Do not use a cuff that is too large because it can result in falsely low readings.2
Rationale: Since hemodynamic changes are less pronounced when standing up from the sitting position versus standing up from the supine position, orthostatic vital sign measurements may be less sensitive in detecting orthostatic hypotension.3
When moving the patient from supine to standing, enlist assistance from another health care team member to ensure patient safety.
If the patient becomes extremely dizzy or experiences syncope, do not take measurements and have the patient lie down.3
Rationale: Blood pressure and heart rate should be measured again after 1 to 3 minutes to confirm the persistent character of the blood pressure change.1,2,3,4,5
Clinical Review: Kerrie L. Chambers, MSN, RN, CNOR, CNS-CP(E)
Published: November 2023
Cookies are used by this site. To decline or learn more, visit our cookie notice.